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New or Est when physician buys practice?

  1. Default New or Est when physician buys practice?
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    I have a client who recently purchased a practice from a retired physician. When she sees the patients for the first time, is it new or established E/M code? The new physician would like to bill new patient codes (due to all the work-up and review she's completing) while the retiring physician states it's establish due to purchasing the office. Any thoughts are welcomed!

    Thank you.

  2. #2
    Location
    Ellenville, New York
    Posts
    1,176
    Default New patient
    Quote Originally Posted by Shannonbeth79 View Post
    I have a client who recently purchased a practice from a retired physician. When she sees the patients for the first time, is it new or established E/M code? The new physician would like to bill new patient codes (due to all the work-up and review she's completing) while the retiring physician states it's establish due to purchasing the office. Any thoughts are welcomed!

    Thank you.
    Refer back to the E/M Guidelines in CPT - "A new patient is one who has not recieved any professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past three years."

    Since the new physician bought the practice and was not part of a group with the retiring physician, she is correct in using new patient codes.

    Lance Smith, MPA, COC, CPMA, CEMC, RHIT, CCS-P, CHC, CHPC

    Director, Health Information Management
    HealthAlliance of the Hudson Valley
    Kingston, NY


    2016 Secretary
    Ellenville, NY Local Chapter

  3. Default
    Thank you - I was using the new patient codes but then became concerned when the retiring physician advised her that was incorrect. Thanks again.

  4. #4
    Location
    Concord, NC or Rochester, NY
    Posts
    154
    Default
    Before you start billing the established patient - what is the tax structure. Buying a practice does not mean it is under the same EIN number - most attorneys and accountants would not let this happen as that would then bring in the possibility of prior payables and even worse - lawsuits.

    If this was set up under a new EIN, then bill for a new patient.

  5. #5
    Location
    Milwaukee WI
    Posts
    4,466
    Default Retiring or Retired?
    So is the original physician completely retired and no longer practicing? Or is he occasionally still seeing patients in the NEW practice?

    If it's the latter ... then these are established patients because the "retiring" physician has joined your practice.

    This happened with my original PMD. About 6 years ago, when he was in his mid 60s he "sold" his practice to another practice. But he's now on THEIR letterhead and he still sees patients occasionally. All those patients from his original practice are established to the new practice.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  6. Default
    Thank you everyone for confirming the new patient billing of the patients. The TIN's are separate and the retired physician completely removed from the practice. Thanks again.

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